Regardless of abstinence, people with a history of alcohol use disorder are less likely to be prescribed direct-acting antiviral therapy to treat hepatitis C, according to findings published in JAMA Network Open.
Direct-acting antivirals (DAAs) are highly effective against hepatitis C virus (HCV), curing more than 90% of treated patients. Studies have shown that individuals with alcohol use disorder (AUD) respond well to treatment, but they can experience difficulty accessing antiviral therapy.
“This study suggests that, although guidelines recommend DAA treatment for patients with HCV regardless of alcohol use, patients with alcohol use disorder encounter barriers to HCV treatment.” wrote Lamia Haque, MD, MPH, of the Yale School of Medicine, and colleagues.
The researchers explored the relationship between alcohol use and receipt of antiviral therapy for hepatitis C. They included 133,753 adults with HCV born between 1945 and 1965. Most (97%) were men, 55% were white and the average age was 61 years. The participants attended at least one outpatient visit at Veterans Health Administration facilities between January 2014 and May 2017 and were followed for up to three years.
The participants completed the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) questionnaire, which evaluates current and past alcohol consumption, drinking behaviors and alcohol-related problems. Their alcohol consumption was categorized as current AUD (38%), abstinent with AUD history (12%), at-risk drinking (6%), lower-risk drinking (14%) and abstinent without AUD history (30%).
Overall, 7%, 33%, 53% and 56% of participants who entered the study in 2014, 2015, 2016 and 2017, respectively, received antiviral therapy within a year of becoming eligible. These rates increased to 47%, 58%, 65% and 65%, respectively, three years later.
The researchers found that people with current or past AUD were less likely to be able to access antiviral therapy for HCV compared with those with more moderate drinking habits. In 2014, people with current AUD (5%) gained access to antivirals within one year of HCV diagnosis, compared with 8% to 10% of individuals in other groups.
By 2017, some 50% of people with current AUD and 49% of those with a history of AUD were prescribed antivirals within a year, compared with 57% to 60% of those in the other categories.
“This cohort study suggests that individuals with AUD, regardless of abstinence, were less likely to receive DAA treatment,” the study authors concluded. “Improved access to DAA treatment for persons with AUD is needed.” They recommended further research to identify barriers to and facilitators of DAA treatment for hepatitis C patients with current or past alcohol use disorder.
Click here to read the study in JAMA Network Open.
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